Understanding the Nuances of Microwave Ablation for More Accurate Post-Treatment Assessment

Kim, Christy

doi:10.2217/fon-2017-0736

Cited by 71 publications

(71 citation statements)

References 35 publications

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“…The primary clinical advantages these advancements in MWA have provided are higher temperatures and faster heating than RFA, shorter ablation times, larger ablation volumes, and less heat sink effect 8. Although MWA and RFA both destroy tissue via thermally induced coagulative necrosis and the frequencies of microwaves used in MWA are from the radiofrequency spectrum,10 the two ablative modalities differ in their mechanisms of energy deposition 11. RFA has limited effectiveness in tissues with low electrical conductivity (eg adipose tissue)8 since it requires an electrically conductive route through which to transfer resistive heat.…”

Section: Introductionmentioning

confidence: 99%

“…RFA applies frequencies from 450 to 500 kHz to destroy tissues in the proximity of the electrode by causing friction that results in heating. The heating produced by RFA is maintained from 50°C to 100°C to avoid charring the tissue and rendering it electrically non conductive 8,11. Charred tissue acts as an insulator that prevents radiofrequency energy transfer to surrounding tissue, thus limiting ablation volumes.…”

Section: Introductionmentioning

confidence: 99%

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<p>Microwave ablation compared with radiofrequency ablation for treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis</p>

Glassberg¹,

Ghosh²,

Clymer³

et al. 2019

OTT

104

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Purpose Percutaneous ablation techniques, including microwave ablation (MWA) and radiofrequency ablation (RFA), have become important minimally invasive treatment options for liver cancer. This systematic review compared MWA with RFA for treatment of liver cancer. Methods The systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials was conducted for randomized and observational studies published from 2006 onwards. A random-effects model was used for meta-analyses and local tumor progression (LTP), technique efficacy, overall survival (OS), disease-free survival (DFS), intrahepatic de novo lesions (IDL), extrahepatic metastases (EHM), length of stay (LOS), and complications were analyzed. Subgroup and sensitivity analyses were also conducted. Results Of 1379 studies identified, 28 randomized and observational studies met inclusion criteria. The main analysis demonstrated that LTP was significantly reduced by 30% with MWA versus RFA (RR=0.70; P=0.02) (all studies) and by 45% with MWA versus RFA (RR=0.55; P=0.007) (randomized studies only). There were no significant differences between MWA and RFA for other efficacy and safety outcomes. Higher frequency (2450 MHz) and larger tumor size (≥2.5 cm) are amongst variables that may be associated with improved outcomes for MWA. Sensitivity analyses were generally congruent with the main results. Conclusion MWA is at least as safe and effective as RFA for treating liver cancer and demonstrated significantly reduced LTP rates. Future studies should assess time and costs associated with these two treatment modalities.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

<p>Microwave ablation compared with radiofrequency ablation for treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis</p>

Glassberg¹,

Ghosh²,

Clymer³

et al. 2019

OTT

104

View full text Add to dashboard Cite

show abstract

“…The use of MWA has increased dramatically over the last several years due to several advancements in the technology and the clinical application. MWA uses electromagnetic fields of either 915 or 2450 MHz to heat tissue to extreme temperatures resulting in the destruction of tumor cells surrounding the microwave antenna [5]. MWA is less invasive than HR [6, 7], but the margins achievable for tumors treated with HR are usually wider than those treated with MWA.…”

Section: Introductionmentioning

confidence: 99%

Microwave ablation compared with hepatic resection for the treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis

Glassberg¹,

Ghosh²,

Clymer³

et al. 2019

World J Surg Onc

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Background Hepatic resection (HR) is the gold standard liver cancer treatment, but few patients are eligible due to comorbidities or tumor location. Microwave ablation (MWA) is an important complementary liver cancer treatment to HR. This systematic review compared MWA with HR for liver cancer treatment. Methods A systematic search of MEDLINE, EMBASE, and CENTRAL was conducted for randomized and observational studies published from 2006 onwards. The primary outcome was local tumor recurrence (LTR), and a random effects model was used for meta-analyses. Results Of the 1845 studies identified, 1 randomized and 15 observational studies met the inclusion criteria. LTR was significantly increased with MWA versus HR (risk ratio (RR) = 2.49; P = 0.016). In secondary measures, HR provided significantly higher 3- and 5-year overall survival (RR = 0.94; P = 0.03 and RR = 0.88; P = 0.01, respectively) and 3-year disease-free survival (RR = 0.78; P = 0.009). MWA exhibited significantly shorter length of stay (weighted mean difference (WMD) = − 6.16 days; P < 0.001) and operative time (WMD = − 58.69 min; P < 0.001), less intraoperative blood loss (WMD = − 189.09 mL; P = 0.006), and fewer complications than HR (RR = 0.31; P < 0.001). When MWA was combined with HR and compared with either modality alone, complications and blood loss were significantly lower with the combination treatment; however, there were no differences in other outcomes. Subgroup and sensitivity analyses were generally aligned with the main results. Conclusions MWA can be an effective and safe alternative to HR in patients/tumors that are not amenable to resection. More randomized and economic studies should be performed that compare the two treatments, especially to determine the target population that benefits most from MWA. Electronic supplementary material The online version of this article (10.1186/s12957-019-1632-6) contains supplementary material, which is available to authorized users.

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“…Most ablation strategies are performed percutaneously, and nearly all are done under CT guidance. The great majority of ablation are performed with conscious sedation, while general anesthesia is reserved for pediatric patients or patients who cannot tolerate sedation alone, although some authors have reported higher feasibility rates and lower peri-procedural pain with general anesthesia [13]. For certain ablation energies, a reference electrode or grounding pad is necessary, which is attached to patient's skin usually on the opposite chest wall or thigh.…”

Section: Procedures and Planningmentioning

confidence: 99%

Image-Guided Ablative Therapies for Lung Tumors

Chan¹,

Lau²,

Ng³

2021

Lung Cancer - Modern Multidisciplinary Management

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While the gold standard for early stage lung cancers is still surgical resection, many patients have comorbidities or suboptimal lung function making surgery unfavorable. At the same time, more and more small lung nodules are being incidentally discovered on computer tomography (CT), leading to the discovery of pre-malignant or very early stage lung cancers without regional spread, which could probably be eradicated without anatomical surgical resection. Various ablative energies and technologies are available on the market, including radiofrequency ablation, microwave ablation, cryoablation, and less commonly laser ablation and irreversible electroporation. For each technology, the mechanism of action, advantages, limitations, potential complications and evidence-based outcomes will be reviewed. Traditionally, these ablative therapies were done under CT guidance with percutaneous insertion of ablative probes. Recently, bronchoscopic ablation under ultrasound, CT, or electromagnetic navigation bronchoscopy guidance is gaining popularity due to improved navigation precision, reduced pleural-based complications, and providing a true “wound-less” option.

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Understanding the Nuances of Microwave Ablation for More Accurate Post-Treatment Assessment

Cited by 71 publications

References 35 publications

<p>Microwave ablation compared with radiofrequency ablation for treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis</p>

<p>Microwave ablation compared with radiofrequency ablation for treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis</p>

Microwave ablation compared with hepatic resection for the treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis

Image-Guided Ablative Therapies for Lung Tumors

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